Pulmonology Coding Alert

Question: I reported critical care (99291-+99292) for two encounters the pulmonologist had recently in the ICU, but the carrier denied one and requested additional documentation for the other. I really thought these situations merited critical care but now I hesitate to use the codes. Can you shed some light on when they are appropriate and what their link is to ICU encounters? Wyoming Subscriber Answer: Critical care can occur wherever the physician performs critical care on a patient -- the patient does not need to be in the intensive care unit (ICU) or emergency department. What drives critical care is the patient's condition, not the location. However, if the pulmonologist provided care in an unusual location, such as the office or a clinic, it is a good idea to document why there was an unusual place of service for such a high-acuity treatment. Conversely, treating a patient in a location where [...]